Dr. Teitelbaum, a well-known fatigue and pain expert, has researched ME/CFS & fibromyalgia patients’ nutritional and therapeutic needs for more than 20 years. This information is excerpted with kind permission* from his educational web site at Vitality101.com.

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We have noted for several decades that the nutrient Acetyl L-Carnitine is low in chronic fatigue syndrome (ME/CFS) & Fibromyalgia, and this deficiency contributes to both the weight gain (see “How Fibromyalgia, CFS, and Stress Can Make You Gain Weight”) and fatigue.... The studies cited here show that it supports healthy mood, comfort and energy in Fibromyalgia as well… – Dr. Teitelbaum

Acetyl L-Carnitine, CFS, and Fibromyalgia

Low levels of the carnitine compound acylcarnitine in the blood or muscles of people with CFS/FMS have been found by different research centers.(1,2) [The most recent report being from the University of South Australia, Adelaide(3).]

Carnitine plays many roles in the body:

• It has the critical function of preventing the mitochondria from being shut down when the system backs up. (It does this by keeping a substance called acetyl coenzyme A from building up and shutting down the TCA cycle and the electron transport system, the cell's effective energy burning systems.)

Several analgesic strategies have been evaluated but the results are moderate and inconsistent. Antidepressant agents are now considered the treatment of choice in most patients.

It has been recently suggested that FMS may be associated with metabolic alterations including a deficit of carnitine. In this multicenter randomized clinical trial we evaluated the efficacy of Acetyl L-Carnitine (LAC) in patients with overt FMS.

Methods: 102 patients meeting the American College of Rheumatology criteria for FMS were randomized into the study. The treatment consisted of 2 capsules a day of 500 mg LAC or placebo plus one intramuscular (i.m.) injection of either 500 mg LAC or placebo for 2 weeks. During the following 8 weeks the patients took 3 capsules daily containing either 500 mg LAC or placebo.

The patients were seen during treatment after 2 (visit 3), 6 (visit 4) and 10 weeks (visit 5). The patients were also visited 4 weeks after treatment discontinuation (follow-up visit).

Outcome measures included the number of positive tender points; the sum of pain threshold (kg/cm2 or "total myalgic score"); the Short Form 36 (SF36) [measures health-related quality of life]; a 100 mm visual analog scale (VAS) for self-perceived stiffness, fatigue, tiredness on awakening, sleep, work status, depression, and muscular-skeletal pain; and the Hamilton depression scale.

Results:

• The "total myalgic score" and the number of positive tender points declined significantly and equally in both groups until the 6th week of treatment. At the 10th week, both parameters remained unchanged in the placebo group but they continued to improve in the LAC group with a statistically significant between-group difference.

• Most VAS scores significantly improved in both groups.

• A statistically significant between-group difference was observed for depression and musculo-skeletal pain. Significantly larger improvements in SF36 questionnaire [health related quality of life] were observed in LAC than in placebo group for most parameters.

• Treatment was well-tolerated.

Conclusion: Although this experience deserves further studies, these results indicate that LAC may be of benefit in patients with FMS, providing:

In a phase I/II open-label trial designed to assess the safety and tolerability of oral supplementation with L-Carnitine, doses up to 3,000 mg a day were found to be safe, well tolerated, and reduce fatigue in patients with advanced cancer, in a dose-dependent manner.

Study subjects were patients with advanced cancer, moderate to severe fatigue, carnitine deficiency (defined as levels of free carnitine <35 for males and <25 for females or acyl/free carnitine ratio of >0.4) and a score of at least 50 on the Karnofsky Performance Status.

Fatigue, depressed mood, quality of sleep and KPS were assessed at baseline and after one week. 27 patients participated in the study, 21 completed the study, and 17 were responders. Subjects were divided into groups and each group was given a successively higher dose of L-Carnitine for one week, starting at 250 mg a day and increasing in increments of 500 mg, up to 2,750 mg a day, plus a final dose of 3,000 mg a day.

None of the subjects reported significant side effects or toxicities.

In the 27 patients who participated in the study:

• Levels of total carnitine and free carnitine were found to increase,

• Fatigue was found to significantly decrease,

• Depression was found to decrease,

• And sleep was found to improve.

Among the 17 responders, L-Carnitine was found to be associated with total carnitine, free carnitine, and fatigue in a dose-dependent manner.

These results suggest that L-Carnitine may be safe and well-tolerated in doses up to 3,000 mg/d. Furthermore, supplementation with L-Carnitine may help to reduce fatigue in patients with advanced cancer.

The authors conclude, "This study provides the basis for the design of future placebo-controlled studies of L-Carnitine supplementation for cancer-related fatigue."

Disclaimer: These statements have not been evaluated by the FDA. This information and the supplements discussed are not intended to diagnose, prevent, treat or cure any illness, condition or disease. They are general, represent the opinions and research of Dr. Teitalbaum unless otherwise noted, and are not meant to replace the attention of a personal physician. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.